Hepatitis E virus seroprevalence and infection status among patients with inflammatory bowel disease undergoing advanced therapy: a prospective single-center observational study

BACKGROUND: Hepatitis E virus (HEV) is a significant cause of acute and chronic hepatitis, especially in immunosuppressed individuals. Patients with inflammatory bowel disease (IBD) undergoing advanced therapy may have an elevated risk of persistent HEV infection; however, evidence in this population is limited. This study evaluated HEV seroprevalence and infection status among IBD patients receiving advanced therapy in an endemic European region. METHODS: In this prospective observational study, 142 adults with Crohn's disease (CD) or ulcerative colitis (UC) treated with advanced therapy between April 2024 and April 2025 were enrolled. Participants completed a structured questionnaire to assess HEV exposure risks and underwent testing for anti-HEV IgG and IgM antibodies as well as liver enzymes. HEV RNA in blood and stool samples was evaluated by real-time PCR in seropositive individuals. RESULTS: Anti-HEV IgG antibodies were detected in 18.3% of participants, while all tested negative for anti-HEV IgM and HEV RNA, indicating no evidence of active or chronic infection. HEV seropositivity was significantly higher in patients with UC compared to those with CD (p = 0.031), but was not associated with demographics, disease characteristics, therapy type or duration, aminotransferase elevation, or assessed risk factors. CONCLUSIONS: HEV exposure among IBD patients receiving advanced therapy is similar to that observed in the general population, and chronic infection is uncommon. These findings suggest that routine HEV screening may not be necessary in all IBD patients receiving advanced therapy; however, this should be interpreted cautiously.